A common problem in California workers’ compensation cases begins at an industrial medical clinic.
An injured worker reports an injury and is sent to Concentra, Kaiser On-the-Job, or another clinic selected by the employer or insurance company. The worker may see a nurse practitioner or physician assistant but never actually meet with a physician.
After a brief examination, the clinic issues a report releasing the worker to full-duty work without restrictions and discharging the worker from medical care.
When the injured worker later hires an attorney and asks to select a new primary treating physician, the insurance company responds that no additional treatment will be authorized because the worker was already “released from care.”
A recent Workers’ Compensation Appeals Board decision explains why that purported release may be invalid.
The Nurse Practitioner in Thomas Could Not Release the Worker From Care
In the July 20, 2026 panel decision of Demetrius Thomas v. Ralph’s Grocery Company/The Kroger Company, the injured worker was sent to Concentra following a work-related low-back injury.
The only medical report in evidence was written and signed by a family nurse practitioner. The report declared the worker permanent and stationary, released him to full-duty work, found no permanent disability, and discharged him from care.
No physician signed the report. The worker also testified that he had never been examined by an actual physician during his treatment at Concentra.
The WCAB found that the nurse practitioner could not legally be designated as the primary treating physician. Because only a valid PTP may release an injured worker from care, the nurse practitioner’s report was invalid for that purpose.
The Board ordered that the worker was not released from care and was entitled to designate a new primary treating physician.
A Medical Clinic Is Not the Primary Treating Physician
The parties had stipulated that “Concentra” was the primary treating physician.
The WCAB rejected that position as well.
A primary treating physician must be an actual physician—not a clinic, corporation, or other medical entity. Identifying “Concentra” as the PTP did not establish that any legally qualified physician had examined the worker, monitored his treatment, or made the decision to release him from care.
That distinction matters. An insurance company cannot rely on the name of a clinic to avoid identifying the person who supposedly acted as the primary treating physician.
Nurse Practitioners May Treat Injured Workers but They Are Not the PTP
The decision does not hold that nurse practitioners are prohibited from treating injured workers.
Labor Code section 3209.10 allows nurse practitioners and physician assistants to provide treatment within their authorized scope of practice and under the required procedures or physician review. But the statute does not transform a nurse practitioner or physician assistant into a “physician” under California workers’ compensation law.
The issue is therefore not simply whether the provider has the letters “M.D.” after their name. Labor Code section 3209.3 includes several types of licensed practitioners within its definition of a physician. Nurse practitioners and physician assistants, however, are not included.
Only a legally valid primary treating physician may issue the report releasing an injured worker from care.
The Threatened Loss of Medical Care Justified Extraordinary Relief
The WCAB emphasized that removal is an “extraordinary remedy rarely exercised by the Appeals Board.” It generally requires a showing that significant prejudice or irreparable harm will result if immediate relief is not granted.
The Board found that standard satisfied in this case. Allowing the decision to stand could have denied the injured worker access to statutorily mandated medical treatment based on a legally invalid release from care.
Although the Board formally granted reconsideration because the trial decision also contained a potentially final finding, it evaluated the treatment dispute under the extraordinary removal standard. The threatened loss of medical care was serious enough to justify immediate intervention.
How to Challenge an Invalid Release From Workers’ Comp Care
An injured worker who was discharged by an industrial medical clinic should obtain and carefully review the medical reports.
Important questions include:
- Who actually signed the release from care?
- What professional license or credentials appear after that person’s name?
- Was an actual physician ever designated as the PTP?
- Did a physician examine the worker or monitor the treatment?
- Is there a physician’s signature anywhere on the report?
When the purported release was issued only by a nurse practitioner or physician assistant, there may be grounds to object to the release and demand the right to select a new PTP within the insurance company’s Medical Provider Network.
That is separate from a dispute over a particular treatment request. When the insurer is denying an MRI, physical therapy, injections, surgery, or another specific recommendation, the dispute may also involve California’s Utilization Review and IMR Process.
A pending QME process also remains important. The WCAB expressly stated that its decision did not invalidate a medical-legal process that was already underway.
A full-duty release can also affect whether the insurance company continues paying wage-loss benefits. Injured workers should therefore understand when temporary disability payments can be stopped.
The Insurance Company Cannot Close Medical Care With an Invalid Report
The Thomas decision is a panel decision and does not constitute binding precedent. It also does not establish that every report written by a nurse practitioner is invalid.
But its reasoning is direct.
An industrial clinic’s staffing model cannot eliminate an injured worker’s statutory right to medical treatment. When no legally valid PTP examined the worker or issued the release, the insurance company should not be permitted to declare the worker discharged and refuse access to further care.
A box marked “released from care” is not enough. The person making that decision must have the legal authority to make it.
About the Authors
David A. Lee and Michael E. Lee are California Certified Specialists in Workers’ Compensation Law and former insurance defense attorneys. Lee Injury Attorneys represents injured workers throughout California, including Los Angeles, the San Fernando Valley, Lancaster, Palmdale, the High Desert, Orange County, the Inland Empire, and Ventura County.
